Axillary Breast Augmentation

Hidden, Underarm Breast Augmentation Scar

The endoscopic technique provides precise control and visualization of the surgery when the axillary incision is used for breast augmentation.

If you desire beautiful breasts, but are concerned about the scars created by the traditional methods of breast augmentation, an axillary endoscopic breast augmentation is a wonderful choice.

With this technique, an approximately 1.5 inch incision is made in the most hidden and hollow area of the underarm. (The incision is about 2 inches if silicone gel implants are used).

The incision is placed in a skin crease, so that the scar is usually well hidden and hard to find after healing has occurred.

A small tunnel is then made to the border of the pectoralis major muscle. The tunnel is continued under the pectoralis major to allow dissection of a sub-pectoral "pocket" for placement of the implant.

The empty saline breast implant is rolled and then inserted through the axillary incision. The breast implant is then filled with saline to the desired size.

Axillary Breast Augmentation Techniques

There are two basic technical approaches to this operation.

The older method is a "blunt" and "blind" technique where blunt instruments are used to open up the sub-pectoral pocket, with no visualization of the surgery to check for important landmarks or to ensure there is no significant bleeding. This technique is not used by Dr. Connall.

Axillary Breast Augmentation In Oregon

Though axillary breast augmentation surgery is widely accepted by many surgeons, it is the least commonly used breast augmentation technique.

In Portland and, indeed, throughout Oregon and Washington, the axillary endoscopic breast augmentation technique is performed routinely by only a few surgeons. The relative limited availability of the axillary breast augmentation technique in Oregon and Washington is due to surgeons' preferences and not patient demand.

We find that for a large number of women the axillary approach is their first choice when deciding on their breast augmentation incision. Given our expertise with axillary breast augmentation, a number of women throughout Oregon and Washington seek us out to perform their augmentation surgery in this fashion.

The breast implants are in position and the axillary scar is in the highest portion of the underarm. This scar usually fades well and is difficult to notice over time.

Our Endoscopic Breast Augmentation Technique

Dr. Connall's technique (the endoscopic technique) is the most modern approach and uses an endoscope, a camera, TV monitor and fine surgical dissecting instruments. Endoscopic surgery is common throughout many surgical specialties.

A common example is arthroscopic surgery in which orthopedic surgeons use endoscopic surgery to operate on joints, such as the knee joint. With endoscopic technique, Dr. Connall can see the entire surgical dissection and perform the surgery with fine cutting instruments. This brings complete precision and control to this surgery, with greater visualization and precision than are achieved with the traditional blind and blunt approaches to axillary breast augmentation.

With axillary endoscopic breast augmentation the anatomical landmarks are clearly seen, the space (or "pocket") for the implant is opened up precisely and there is minimal bleeding.

Breast Implant Placement

After the space for the implant is opened, the pectoralis major muscle is cut (or "released") along the base of the breast. The implant is then soaked in an antibiotic and saline solution and then the implant is placed in the pocket. If a saline implant is used, the implant is then filled. (Silicone gel implants come pre-filled and sealed from the manufacturer.) The size, symmetry and appropriateness of the pocket dissection are then assessed. If needed, the patient's back will be raised as in the sitting position and the results will be assessed with the patient "sitting up" (while still under general anesthesia). Silicone gel implants can also be placed with this approach, but the incision is slightly longer to allow placement of the pre-filled silicone gel implant. The incisions are then closed with hidden, dissolvable sutures. Tissue glue or tape, gauze and a clear bandage are then placed over the wounds. Finally, a post-surgical sports bra is placed.

Endoscopic Breast Augmentation Recovery

The recovery very similar for all three of the approaches to breast augmentation. The post-surgical pain is similar for all three approaches, as well. This is true because the majority of the pain after breast augmentation is from the manipulation of the muscle and creation of the space for the implant. These maneuvers for creating the space for the breast implant are nearly identical with all three approaches to breast augmentation. With the axillary approach there is additional pain under the arm, of course. But this is not severe and overall does not affect the recovery much compared to the breast fold and areolar augmentation approaches. So, we do not think post-op underarm pain should be a deterrent for women desiring axillary breast augmentation.

After breast augmentation, no drains, pain pumps, or chest wraps are used—you simply wear a post-op bra, which is similar to a sports bra. You go home a couple of hours after surgery to rest. The day after surgery, you start feeling well and can shower and shampoo and blow-dry your hair. Most patients can return to most of their home and work activities within 5 to 7 days. Some patients return to work in 3 to 4 days after surgery, but this is not recommended. You can perform some exercises three weeks after surgery and you can resume full activity six weeks after surgery. For more information about the surgical experience please see our sections on day of surgery and your recovery.